The Unseen Impact of COVID-19 on Non-COVID ICU Patients: A Critical Analysis
As an author of a recently published population-based study, I am eager to share some intriguing findings about the impact of the COVID-19 pandemic on critically ill patients without COVID-19 infection. While we've all been hearing about the outcomes for COVID-19 patients, it's important to also consider the effects of the pandemic on those who were admitted to intensive care units (ICUs) for other reasons.
Our study aimed to demonstrate the characteristics and outcomes of non-COVID patients admitted to an ICU during the pandemic and compared them with a similar cohort from the previous year. We analyzed data from adult patients (18 years old and above) admitted to an ICU in Ontario, Canada, during the pandemic and non-pandemic periods, specifically between March 1 and June 30 in 2019 and 2020.
The primary outcome we assessed was all-cause in-hospital mortality, while secondary outcomes included hospital and ICU length of stay, discharge disposition, and receipt of resource-intensive procedures such as extracorporeal membrane oxygenation, mechanical ventilation, renal replacement therapy, bronchoscopy, feeding tube insertion, and cardiac device insertion.
Our study involved 32,486 patients in the pandemic cohort and 41,128 in the non-pandemic cohort. We found that age, sex, and markers of disease severity were similar between the two cohorts. However, there were some key differences. Fewer patients in the pandemic cohort came from long-term care facilities, and they had fewer cardiovascular comorbidities.
The most concerning finding was an increase in all-cause in-hospital mortality among the pandemic cohort (13.5% vs 12.5%, p < 0.001), representing a relative increase of 7.9%. Patients admitted with chronic obstructive pulmonary disease (COPD) exacerbation during the pandemic experienced an even greater increase in mortality (17.0% vs 13.2%, p = 0.013), a relative increase of 29%. Mortality among recent immigrants was also higher in the pandemic cohort compared to the non-pandemic cohort (13.0% vs 11.4%; p = 0.038), with a relative increase of 14%.
Despite these differences in mortality rates, we found that the length of stay and receipt of intensive procedures were similar between the two cohorts.
Our findings reveal a modest but significant increase in mortality among non-COVID ICU patients during the pandemic compared to a non-pandemic cohort. These results serve as a reminder that future pandemic responses must consider the impact on all patients to preserve the quality of care. Addressing the needs of non-COVID patients, especially those with COPD and recent immigrants, is essential to minimize unintended consequences and ensure a comprehensive healthcare response during challenging times like these.
Here’s a link to the paper